Abstract
Purpose
The perioperative and oncological outcomes of laparoscopic radical nephrectomy (LRN) for T1–T2 renal cell carcinoma (RCC) are well established. We aim to determine whether LRN is a comparable alternative to open radical nephrectomy (ORN) in the treatment of T3 RCC using a matched pair analysis study design.
Methods
A review of a prospectively collected database at the Western General Hospital, Edinburgh, between 2000 and 2011 was conducted. Patient pairs were matched based on age at operation, gender, histological subgroup, maximal tumour diameter, TNM stage and grade. Patient demographics, operative and post-operative outcomes were compared. Overall, cancer-specific and progression-free survival [overall survival, cancer-specific survival (CSS) and progression-free survival (PFS)] were estimated using the Kaplan–Meier method.
Results
From 252 patients with T3 disease, 25 pairs were matched. Patients were of median age 66.2 years, 64 % male. Tumours were all clear cell RCC, were stage pT3a (32 %) or pT3b and had maximal tumour diameters of 8.7 cm for LRN and 10.0 cm for ORN. Estimated blood loss (100 ml LRN; 650 ml ORN, p < 0.001) and length of post-operative hospital stay (4 days LRN: 9 days ORN, p < 0.001) were lower in the LRN group. Operation time and post-operative complication rates were comparable. CSS and PFS were comparable with a mean CSS of 91.3 months for LRN and 88.7 months for ORN.
Conclusion
This study reports the longest median follow-up in a T3 LRN cohort. In matched patients, LRN has been shown to have a superior perioperative profile to ORN for the treatment of pT3a/b RCC, with no adverse effect on midterm oncological outcomes.
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Acknowledgments
We are grateful to the help of all surgeons involved in the care of the patients included in this study, especially Mr. Tim Hargreave.
Conflict of interest
The authors declare that they have no conflict of interest, and no funding was received for this study.
Ethical standard
Formal ethics committee approval was not required for this study, but the study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
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A. Laird and K. C.C. Choy have contributed equally to this work.
G. D Stewart and A. C. P. Riddick have contributed equally to this work.
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Laird, A., Choy, K.C.C., Delaney, H. et al. Matched pair analysis of laparoscopic versus open radical nephrectomy for the treatment of T3 renal cell carcinoma. World J Urol 33, 25–32 (2015). https://doi.org/10.1007/s00345-014-1280-y
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DOI: https://doi.org/10.1007/s00345-014-1280-y